26 June, 2006

Politics have little place in forensic science, yet the human factor allows political agenda to creep into the least appropriate places. Our office was unfortunate enough to be a focus of local political and media attention for over a year and even the subject of national attention for a short time. This was not a pleasant time for any of us.

If you have read the previous entry with the article entitled "Dead Reckoning," then you have already learned about the case that started this all. In summary, five high school girls died in a single-vehicle crash one March afternoon while returning from prom dress shopping. Initially, it was unclear as to what caused the accident and only this was known: the vehicle was traveling at a high rate of speed, left no skid or yaw marks indicating attempts to brake, and it collided into a high embankment. Four of the five girls were killed on impact, and one was transported to Hospital at UPenn (HUP) by helicopter where she was pronounced dead in the ER.

The accident, along with a series of events that sparked afterwards, changed many lives.

Our office worked in conjunction with the Pennsylvania State Police to determine what caused the crash. One key piece of evidence obtained but not recognized immediately as important was the presence of several cans of Duster II, a compressed air keyboard cleaner, found in the back seat of the vehicle. When preliminary toxicology reports were obtained, propane was discovered in the driver's blood. As this is an odd finding, our chief forensic pathologist, Dimitri Contostavlos, became suspicious that inhalants may have been involved and began researching the practice of "huffing" propellant-based substances. What he found was that this was becoming an increasingly popular method of obtaining a high, particularly among teens.

Several problems exist with this practice. The chemicals in the propellants displace oxygen in the brain, which is dangerous in itself. Huffing can also cause sudden cardiac arrest, nerve damage, brain damage on several levels (especially with prolonged use), and damage to internal organs. Additionally, it causes temporary loss of consciousness or impairment. In the case of the girls' deaths, upon further toxicology tests it was found that not only did all four of the decedents who came into our office have the Duster II chemicals on board, but the driver had the highest levels.

From the parents' perspectives, this was already a nightmare. Add to the nightmare the discovery that their daughters had been engaging in a dangerous activity that directly lead to their deaths. That is a tough pill to swallow. Our pathologist spoke to the PSP about releasing the information, first to the parents, then to the media in order to properly educate the public about the huffing trend. Somewhere, it seems, communication deteriorated. The State Police did not notify the families of the release to the media. Dr. Contostavlos had spoken to the families but did not realize that they were unaware that the information was being released. Hence, although the families were aware of the circumstances, they were surprised to read about the findings in the county newspaper the day after they were informed.

This caused an uproar. I cannot imagine what the parents must have been going through. I do know that the media seemed all too pleased to talk to the parents and publish their outrage. At what? The fact that their daughters died because they were engaging in a dangerous practice that apparently puts many young people at risk? No. They were outraged at Dr. Contostavlos. In forensics, we are frequently the target of grief and rage, and to an extent, this is accepted by most who work in the field, however misdirected it might be. I personally have had people scream at me not to take their deceased loved one away from them. The Grim Reaper image is one that goes with the territory.

This, however, went beyond all reason. The parents went to the press and the county council demanding that Dr. Contostavlos be fired. Their argument was that there was no medical evidence to suggest that huffing caused the accident or that their daughters deliberately inhaled the contents of the cans. They were angered by the release of these findings to the media without first discussing it with them, and it seemed not to matter that the PSP had a role in not informing them of this.

I can say this: Dr. Contostavlos probably should have arranged a meeting with the families prior to the press release. Clearly, relying on the PSP to do this, whether or not they offered, was a mistake. He would be the first to admit that talking with families was his least honed skill, and that he lacked patience and sometimes tact, but in retrospect, this might have prevented some of the repercussions.

Maybe.

There is a good chance that nothing he could have done would have made any difference. He couldn't change the facts, nor could he summon the dead to rise again. Nothing less was acceptable.

During the year that followed this tragic accident, many things were uncovered. The parents all insisted that their children were completely drug and alcohol free and would not have dreamed of huffing from aerosol containers. But it was learned that the girls, hailed by the media as "the five angels," certainly had their share of problems in life. One had been in rehab for cocaine abuse. The fifth girl, who died at HUP and became a Philadelphia Medical Examiner's case, was found to have both the propellant chemicals and marijuana in her system. Does this make them bad people or troublesome teens? Of course not. It does indicate that at least two of them had prior experience with the use of a controlled substance. Angels? Perhaps by some definitions. Drug free? Not so.

This does not and should not take away from the grief felt by families, friends, and the community at this loss. It hit our office personally, as our secretary was very close with one girl's mother. As hype rose among the media and politicians and surrounding community, tension rose in our small office. There was as much of a riff in our office as among the county residents. Some were very sympathetic towards the parents; in particular, the family of a girl who had been killed a year before while driving drunk and high, and who also paralyzed her friend. The father of the injured girl spoke out in favor of Dr. Contostavlos and his efforts to not only defend his findings, but to educate the public about this apparent huffing problem. For months, the case was in the newspapers and on TV almost daily, and it seemed to be all anyone in the county spoke about. It was the subject of radio call-in programs.

County Council eventually succumbed to the pressure of the most vocal members of their constituency and announced that after 20 years, they would not be automatically renewing Dr. Contostavlos's contract as Medical Examiner. Rather, they would interview several candidates, and he was welcome to apply for the position as well. This political tactic came as no real surprise to anyone who had been involved with or followed the story.

That is when the nightmare really began for us.

Dr. Contostavlos is someone for whom I have and always had tremendous respect. From the first day I walked into his morgue, he educated me unrelentingly about pathology, scene investigation, medicine, and many other aspects of forensics. While he was not always good with people, he was by no means always bad with people. I have heard him speak comfortingly and empathetically to families who have lost someone, in person and on the phone. I have also known him to be blunt with families when challenged, but not frequently. I've seen him throw things and I've seen him hug people. I saw and heard him lose his temper at staff members and police many, many times. I've seen him pick his nose and flick his "findings" across the room. Cultured and alternately crass, kindly and beastly, logical and outrageous, the man is a true paradox.

When it was announced that the position of Chief Medical Examiner would be opening up, we were not shocked, yet we had no idea how this walking paradox of a man was going to react.

His initial response to the media attention was to launch a rather expansive educational campaign. He spoke to schools, parent groups, police, and hospitals basically anyone who expressed interest in an effort to broaden awareness about the practice and dangers of huffing. While he did a considerable amount of anticipated ranting in the office, it seemed he was channeling this fervor in a positive way, at least publicly. Then Dr. Contostavlos was interviewed on 20/20 after the story began getting national attention. Here is the interview summary:

MEDICAL EXAMINER LET GO AFTER CONTROVERSIAL RULING IN THE

DEATHS OF FIVE TEENAGERS; CHRIS CUOMO REPORTS ON A REPORT

THAT TORE A COMMUNITY APART, ON ABC NEWS “20/20 DOWNTOWN”

A month after five high school senior girls died in a tragic car accident, the county medical examiner determined that four of the girls had been inhaling a potentially toxic cleanser, an inhalant commonly abused by teenagers. The report outraged the community; and a year later, the medical examiner’s contract was not renewed. Was it a case of killing the messenger?

“I think it’s a common thing to blame the messenger of bad news. I think that’s what it is,” says the former medical examiner, Dr. Dimitri Contostavlos, who was the county’s medical examiner for 20 years. And, according to the National Inhalant Prevention Coalition, inhalant use is a widespread problem in Delaware County, where the senior girls attended high school in suburban Philadelphia. “Seniors in Delaware County had two times the usage levels of inhalants as anybody else in the state or the country,” said Isabel Burk, who works for the Coalition.

The head of the local county government says the Delaware County Council had plenty of reasons to be unhappy with the doctor and insists its action was not in retaliation for the examiner’s report about the accident. Last week, the county council suspended Dr. Contostavlos immediately, claiming that he had created a hostile working environment in his office and had engaged in “many instances of bizarre, outrageous, and completely inappropriate behavior.”

Others disagree and say Dr. Contostavlos is paying the price for uncovering a community’s ugly secret. “I think in America we do kill the messenger. It’s very difficult to be a truth teller in America today. You usually end up sacrificing something and often, it’s your job and your livelihood,” Ms. Burk tells Mr. Cuomo.

Elizabeth Vargas is the host of the March 9 edition of “20/20 Downtown.” Victor Neufeld is the executive producer.

As time progressed, Dr. Contostavlos seemed to regress, until for all appearances, he had he lost perspective. While the candidates were being selected to interview for the position, he joined online groups and forums (except that he asked his staff to post what he wrote because he didn't want to deal with technology). He wrote scathing comments about other pathologists who were being interviewed, and continued to rant via email to listserve members about how he was being sabotaged by the county politicians.

It seemed that not a day went by without obsessive, paranoid ranting from the doctor. The tension in the office grew as the doctor began placing blame for the situation on everyone except the investigators and the autopsy technician, which is not to say that he did not subject us to it.

To make matters worse, in the heat of all of this, our investigative supervisor (who had an almost exclusively administrative role in the office), was involved in a drunk driving accident in which he injured himself and a family of three. He did not return to work due to injuries, and because of his DUI, he was ultimately asked to retire. It was more publicity, and it was all negative.

Eventually, three candidates were interviewed in addition to Dr. Contostavlos. Eventually, one was selected and an offer was made. It was at that time Dr. Contostavlos was given notice that his contract would expire approximately three months from then. The assistant pathologist, who had been the target of much rage from Dr. C. decided to move back to Oregon so he and his wife could be closer to their families. There was supposed to be a transitional period where the assistant pathologist and the new medical examiner would work together, then the assistant would leave.

This did not happen. Dr. Contostavlos seemed to further decompensate. He grew more openly hostile and paranoid every day, and his bursts of rage and fits of temper finally frightened a visitor to the point of reporting him to County Council. The next day, just as I came on duty for my rotation, he was escorted off of the property by county police and told he was not to return, except once when the office was not occupied and he was supervised, to gather his belongings.

It was a sad way to see such a gifted pathologist and fascinating person end his tenure at the Delaware County Medical Examiner's Office.

In the days and weeks that followed, there was still much media attention, but it did begin to wane a bit. But it was far from over, because then the Delaware County Criminal Investigation Division (CID) showed up at our office.

They began by segregating the staff and interrogating us about Dr. Contostavlos autopsy practices. It seemed that they were under pressure from the council to find something - anything - that would help publicly justify their reasons for removing him. I was honest and answered the detectives' questions. I don't know what was said in other interviews, but I do know that several people in the office loathed him. Others, like myself, seemed to accept him for who he was and just wanted the whole mess behind us. But before we knew it, terms like "corpse abuse" were appearing in the paper, and the media hype resumed.

Eventually, our new pathologist arrived and the public focus shifted to that. During this entire ordeal, we were still attempting to perform well in our daily forensic functions, which were difficult enough by nature. Was any lesson really learned? Refer to this chapter title; propagating "safe history" is the only way to remain inscrutable in a public domain. Publicizing controversial information, even with the best of intentions, and there is a good chance one will pay dearly for it. That might be as tragic to me as the deaths of these girls, themselves - the tragedy of which, in sad irony, was somewhat lost in the hype.

After awhile, the local media found other stories to publish and left us alone. But at the Delaware County Office of the Medical Examiner, six staff members were left stunned, traumatized, and overwhelmed in the wake of the past year's events.

14 May, 2006

For those of you following this series (which has been on a long hiatus), I will soon be posting the next chapter. The article included below provides some interesting background, not only about the scene that sparked a chain of events which changed our office forever, but about the personality of the pathologist I worked for during four of my five years as an investigator.

I did not read this article until recently. It was published during a time in which our office was the subject of much media attention, locally and even nationally. Those of us involved grew weary of seeing articles, interviews, and reports about our office on a daily basis and eventually began to avoid reading them.

This one I missed. Now, years later, I read it with not a little nostalgia and some degree of awe - and a bit of sadness as well.

What I appreciate most about this article is the way journalist Ivan Solotaroff captured the very essence of this intriguing man who I have always found so difficult to describe.

"Dead Reckoning"

By Ivan Solatoroff From the July 1999 issue

Philadelphia Magazine

Dimitri Contostavlos, the medical examiner of Delaware County, rifles the top left drawer of his desk for the vertebra of a man he autopsied 30 years ago. It looks a bit like a fossil a small, flat circle of bone in a yellowed Ziploc though the pride and mystery on Dimitri's face as he hands it across the desk to me speak otherwise. "This is the body's uppermost vertebra," he says. "Called Atlas. He on whose shoulder the world rests."

Some leave their names on mathematical constants or hospital wings. The dark secret of this disk a murder is Dimitri's bid for immortality. Using the Phillips screwdriver of his Leatherman, a Swiss Army-type tool he bought recently and uses often, he points to a tiny fracture on one side: what has become known as the "Dimitri lesion." With great clarity and a vestigial South London accent, he explains how it helped him to declare that the bone's original owner died not from stroke, as had been assumed, but from a blow to the side of the neck. "Of the karate-chop variety," Dimitri concludes, flashing one of his agreeably didactic smiles as he returns the bone to his desk. "The neck is of huge importance to my work, you know. All mammals go for it when they want to kill. And that includes humans lacking a knife or a gun."

The neck is also the area that gave Dimitri his nickname: "Quinsy." That's not a typo of the TV M.E. played by Jack Klugman. "'Quinsy,'" Dimitri explains, "is an abscess of the neck, caused by staph or strep. It means I am, or can be seen as, an extreme pain in the neck. Particularly by those who do not want to hear what I have to say."

Some particularly unwanted words vaulted Dimitri into the national spotlight this past February: a report that five popular girls at Penncrest High School, all model students, were not the innocent victims of a freak highway crash on a stretch of U.S. 1 called Dead Man's Curve, as was originally and widely reported. They were, rather, the latest statistic in what the National Inhalant Prevention Coalition, a nonprofit organization, calls "a silent epidemic": huffing, the late-20th-century variant of glue-sniffing, currently America's fourth most common form of substance abuse. Dimitri's findings, published with a clear eye to alerting the county to the epidemic, led mostly to months of extreme bitterness. The parents of the girls refused to accept the findings. Dimitri, in turn, still refuses to accept their denial.

Dimitri's corner office, sandwiched between Delco's library headquarters and the county morgue, is in a peaceful complex set far behind the Fair Acres Hospital in Lima. The buildings are newly refurbished but so institutional and ugly that they look old, backed by a thick stand of hardwoods that would probably seem beautiful if they were anywhere else. As you drive up to the largely empty parking lot, there's simply no doubting you've come to the end of the line.

In a darkened office next to Dimitri's, his fellow examiner, Ed Wilson, is flipping through slides of a severely damaged brain. "An epileptic's," Dimitri advises me. "Went into seizure in hospital while awaiting treatment for an earlier seizure suffered at home. We're trying to determine which of the two led to the fatality, which may or may not lead to an investigation for negligence followed, doubtless, by a lawsuit. We're thought of as a branch of the police, but much of what we do here is civil, rather than criminal, investigation." Delco, population 550,000, looks into some 1,200 deaths a year. Only half make it to Dimitri's office, and of those, only half will undergo autopsy. "It averages at one a day," he says. "Today, none, so we can have a nice long lunch."

The morgue, at the end of which, is dominated by the autopsy room, which looks like an industrial kitchen. Colanders and sieves, used to filter earth and gravel from crime scenes, share the stainless steel shelves with ladles, saws, Adolph's Meat Tenderizer (whose purpose I don't ask after), a 10-inch chef's knife Dimitri found so good for cutting meat and vegetables at home he brought it to work. Over the autopsy table is a large greengrocer's scale. The refrigerators are in the next room: four individual shelves and a large walk-in, which is much harder to walk into than I had imagined. Currently inside are an unclaimed nonagenarian, a fetus that had been dropped into a tulip bush by the 15-year-old mother, and two others I'm happy to learn no more about: "Wisdom," wrote Horace, "sets bounds, even to knowledge."

Those bounds, one quickly learns, are the deep structure of this place and of the controversies that seem to constantly surround Dimitri Contostavlos. Death may well be our last taboo: that which cannot be looked at directly. Dimitri, who seems to revel in occasionally having the weight of the world or at least of Delco on his shoulders, has no compunction about making us look at death without flinching or altering the details with inexactness, secrecy, symbolism. Whether autopsying a mummified baby found wrapped in newspaper dated 1938 in the crawlspace of a Ridley Township home, or a retarded woman who died in her bathroom giving birth to a baby she hadn't known she was carrying, Dimitri has a gift for dispassion, plus a ready finger to point at anyone he feels has either bungled his job or is dangerous to the public weal. The list can range from policemen, social workers, politicians and members of his own eight-person staff to Jack Kevorkian, whom he calls an "exhibitionist and ego merchant," and chiropractors: "Dangerous people," he tells me, noting that I twist my neck often to relieve stress. "That cracking sound you make when you do that," he asks. "Do you imagine that it provides you with some sensation of relief?"

His pet peeve is coroners. Dimitri, by contrast, is a medical examiner, of whom there are fewer than 250 in America. "The very title of these colleagues," he pronounces, "speaks of their archaic, anachronistic institution. Coroner. From corona, or crown. A man who did his majesty's bidding, everything from estates to smuggling. Your average American coroner, an elected man, is a part-timer who averages $40,000 to $50,000 per year. His most common occupation? Doctor? Undertaker. His reason for being there? Politics. His talent, or lack thereof? Utterly random."

No one disputes Dimitri's talents certainly not his employers, who year to year have paid him the highest salary in the county but even his admirers admit he can be difficult. As his colleague Halbert E. Fillinger M.E. of Montgomery County and the state's only other forensic pathologist puts it, "He is a hair shirt."
Dimitri, who moved seamlessly from medical school in Dublin, Ireland, to forensics (which is, simply, the juncture at which law and medicine meet), knew from the first he had "zero patience for the so-called human side of medicine. The bedside manner. The patient in denial. Hysterical Mrs. Smith with her thrice-monthly appointments and nothing remotely the matter with her. This is 50 to 90 percent of a practitioner's work, you know. What I do, as your health enthusiasts like to say, is 100 percent organic. You're not a vegetarian, I trust?" he asks, scratching his head as we head for Bobby's in Newtown Square, his favorite seafood restaurant. "Utter rubbish."

One learns to take these pronouncements in stride with Dimitri, who becomes a kinder, gentler man with each step he takes from the morgue's front door. More precisely, he becomes a more interesting man with each sentence: a man of parts no morgue puns intended. The son of a prosperous ship's broker, Greek-born but raised a Londoner, he is what they used to call a cosmopolitan. After a truly English unhappy childhood spent in boarding schools and public schools in Sussex and the Lake District, he was privileged to see the blackouts of the Second World War from hotels in Maidenhead and a Welsh coastal town whose name he evokes with great elan: Devil's Bridge.

He failed to get into a good university in England, however, and wound up at Trinity College, Dublin. He enjoyed it immensely: "I'd never realized what a xenophobic, imperialistic race the English were until I went to Ireland," he says. "Once there, I became quite an Anglophobe and determined never to return." He credits a lecturer in forensics at Trinity, Jackie Wallace, with his straight line to the profession: The current M.E.s of Belfast and Dublin were also in the class. "With that decided," Dimitri says, "it was only a question of which English-speaking land I would emigrate to. I'd been lucky enough to marry an Irish girl" his wife, Ursula "and in those days, the U.S. quotas were lax on northern Europeans."

He wound up at the M.E.'s office in Camden, New Jersey ("the best-paying job available"), and spent 16 years working his way up between jobs in Chappaqua, New York; Baltimore; and Dade County, Florida (where he discovered the Dimitri lesion), then Philadelphia. He moved into his present job in 1979, when Delco, dissatisfied with the coroner system it had always used, created the position. He held it single-handedly until last year, when he told the county he wanted to take a pay cut and create a second M.E. slot, now filled by Ed Wilson. He admits to having no patience for the arts he watches few movies and finds interest in poetry and novels almost baffling but says he can't recall an hour that he's spent idle. He grew up skeet shooting and snipe-hunting, became fascinated with flying gliders, golfing and, currently, with fishing and gardening "roses, in particular." He has a passion for gadgets mostly manual stuff like his Leatherman tool or the huge light microscope that occupies half his desk, but he's slowly warming to technology: a cell phone he makes show of being unable to operate, until a D.A. from Cherokee County calls about a case that might involve the Dimitri lesion. He also has a Sharp hand-held computer he's forever leafing through storage areas like Cracked Lung Studies, Unremembered (names of friends and celebrities he always forgets), and Palindromes, for which he has a flair a recent composition spells out Dimitri's passion for the tales that dead men tell: Evil all its sin is still alive.

A brief autopsy of Dimitri's C.V. simply to help understand this complex man and his periodic skirmishes with the public: His disdain for the English notwithstanding, Dimitri is a model specimen of that most British of types, the perfectionist hobbyist. Endlessly curious and relentlessly pedagogical, he's a man who works hard to develop an opinion, which once held will be forever the truth. It extends to his work and the simple language of his reports. It's a rare doctor who doesn't hide behind jargon to create an expensive allure or simply to hide the brutality of what he has to say. Dimitri, if anything, hides in the brutality and in the nakedness of his verbiage. After 33 years, he must know how brutish it might seem to the parents of a teen who don't particularly want to compound their grief with hearing about suicide. Or as with his 1984 autopsy of a young Navy man who died in Australia and was brought back by suspicious parents that there was in fact no neglect or violence, simply a severe asthma attack.

Mention the controversies his bluntness sometimes evokes, however, and Dimitri seems baffled. He refers back to his distaste for the "human side" of medicine, or simply says it doesn't pay to obfuscate. "In the Philly office," he says, "if there was an issue of a suicide being denied burial in hallowed ground, we'd put on the death certificate, Killed himself while balance of mind disturbed. I just had one, and I don't remember if it was out of rote reflex or just to make them feel better, but I wrote that phrase again. Man, they were irate: 'How dare you! He had no history.'" He shrugs his shoulders helplessly.
Dimitri was on vacation in Greece the Saturday afternoon 17-year-old Loren Wells of Media, her friends Tracy Graham and Rachel M. Lehr, also 17, and Shaena E. Grigaitis and Rebecca J. Weirich, both 16, went shopping for prom dresses in Wells's red Chevy Corsica.

Shortly before 4:30, heading north on U.S. 1 at 65 to 75 m.p.h., blasting a Black Street and Mya cassette, Loren Wells lost control of the Corsica. Veering first into the right shoulder, she swerved across lanes into the berm dividing the four-lane road. She appeared to regain control but within seconds had swerved back again, this time into oncoming traffic. She hit a utility pole, cut back across her side of the road, and slammed head-on into a tree on the right shoulder at full speed. The impact sent the engine block through the front seat, killing her and three other girls instantly. The fifth, Tracy Graham, died at HUP several hours later.

The autopsies, conducted in Dimitri's absence by Ed Wilson, raised no red flags. Among the items in the Corsica, the mechanic handling the wreckage did find a can of Duster II a spray used to clean computer keyboards. He gave it to state police, who brought it to the M.E.'s office. Its significance went unrecognized, however, and it was returned to the mechanic.

Wells's blood work, sent to the state lab in Lyonville, showed no signs of alcohol abuse, which was no surprise. The girls were known as clean-living hardly the types to be drinking on a Saturday afternoon. The pathos was ratcheted up days later, when a video the girls had made a week before the accident warning of the evils of smoking and drinking and drug abuse on the road was shown on television.

Then Dimitri returned from Greece. Preliminary findings of a freak accident were ready to go out, but something about the report didn't smell right to him. A phone call to Corporal Fran Winkler, the Accident Reconstruction man from the Pennsylvania State Police, heightened his doubts. For one thing, he knew the stretch of U.S. 1. Halfway between Wawa Headquarters and the Franklin Mint, less than five miles from his office, it was called a "dead man's curve," an appellation repeated ad nauseam in the media for what was actually an easily driven uphill grade. As he learned from Corporal Winkler, the Corsica had been out of control for almost half a mile. "After 33 years of road deaths," he says, "you learn that bizarreness, barring extreme youth or agedness, means substance abuse."

When Wells's toxicology report came back from Drugscan, the Willow Grove lab he routinely uses, Dimitri reopened the case. One of the principal tools for analyzing blood is a gas chromotograph, a centrifuge-created graph of specific trace elements. Confirming the state's blood lab, Well's chromotograph showed no sign of ethyl alcohol, but it had a large, highly unusual spike for methyl alcohol. Mark Lichtenwalner, a toxicologist at Drugscan, was confounded by the result: "I think it's propane," he advised. Dimitri was piqued.

Two days later, Dimitri's investigative supervisor learned about the can of Duster II and had it brought back to the M.E.'s office. Dimitri read the contents, then got back on the phone with Lichtenwalner and asked if the spike could have been created by difluorethane a variant of freon. By the time the positive results came back, Dimitri, who had never heard of huffing, had learned all about the "silent epidemic."

"The chemicals for it," he says, "are in hundreds of everyday products. Paint thinners, cleaning fluids, marking pens, aerosol cans, bottles of Wite Out. Kids soak their sleeves in solvent and sit around sniffing it. Or with cans like Duster II, they invert it, then release the substance, which has become liquid. In cars, they lay it on dashboards then huff while they sit there or, worse yet, while they drive."

He'd also put together a chronology of the afternoon, tracked down the woman in the Springfield Mall who had sold Shanna Grigaitis the can of Duster II (Shanna had tried to buy three cans but only had enough money for one), then performed the acid test on himself. Opening a can of the cleaner in the back of his car with the windows closed, he breathed deeply for some five minutes, then emerged and had his blood tested. It confirmed that the girls could not have become exposed to second-hand fumes. No accident.

He called Corporal Winkler and asked if he agreed that the Duster II had been the "agent of destruction."

"One hundred percent," said Winkler, who added that the State Police, who were of course quite familiar with the "silent epidemic," also came to that conclusion.

"Should you release the information," he asked, "or should I?"

"Why don't you," said Winkler.

The parents of the five girls, accompanied by a state policeman, came to confront Dimitri the following evening. Dimitri will speak freely on almost any subject, but he declines to discuss the meeting, except to say it was "quite emotional at times." He does admit, however, to a prior run-in in an unrelated incident with one of the girl's parents. "It came after an autopsy report that I issued two years ago," he remembers as he takes his first bite of blackened salmon at a back booth in Bobby's. "Another death of a teen at the wheel, this time also involving the passenger's permanent brain damage. As I recall, it made news largely because the death occurred the same weekend as Princess Di. Good food, eh?" Dimitri draws his knife in a long motion across the plate, separating the salmon filet from the bone. "Princess Di," he says. "There's another open-and-shut case of driver impairment."

The parents of the Penncrest girls issued a written statement: "[I]t seems clear to us that there is inconclusive evidence that our children intentionally abused the cleaning agent involved." They added that the substance had been airborne, then declined further comment, asking that they be allowed to "resume the healing process."

Dimitri recalls that Channel 6, reporting on the challenge to his findings, ended with the words, "But the damage is already done." Nothing could have made Dimitri angrier. "The damage," he says, "was done when a Chevy Corsica hit a tree at a speed exceeding 65 mile per hour. Listen, I'm a physician, and I understood the importance of the healing process that the kids' parents raised. And though I understand that denial might be part of that healing process, at some point, it doesn't change the truth of my findings or represent them as the intrinsic danger."

And on he goes. I've spent five hours with Dimitri, riveted to almost every word. Suddenly, however, I find myself almost unable to listen to what he has to say. It's not that it seems repugnant, or wrong, or boring. My mind simply won't focus on his words. As he speaks, I recognize words, fragments even, but the general thrust is completely lost on me. "This is taboo," I tell myself, fascinated by the cognitive dissonance.

"But let's speak of something else, finally," he says. "You say your wife gardens. Have you bought her a Roto-Tiller?"

"No, we're going to rent one."

"Rent one!?" he bellows. It's the first sound of genuine anger I've heard, despite the long harangue. "Two hundred bucks!? For endless weeks of domestic peace? C'mon man," he says, getting that immensely agreeable and didactic smile on again. "Get your head on straight."

27 February, 2006

The first vehicular death I ever worked was like no other I’ve seen. I managed to go all summer and fall in training without being on duty for one traffic death other than a pedestrian struck by a car. Then one night in early December, while I was still in training, the skeleton crew (no pun intended, really!) operating the M.E.’s Office called me in to cover an overnight shift. One investigator had recently resigned, and the three who remained were weary from nonstop rotation. I was thrilled to have this responsibility, but the one rather common type of death with which I had no direct experience was vehicular deaths, so this was the one type of death I did not want to get a call to investigate.

So of course the only call I had all night was for just that – a vehicular accident. I don’t believe in fate at all, but it is interesting how my life has a habit of forcing me out of my comfort zones in rather extreme ways. While I don’t always relish this at the time, it does amount to some phenomenal learning experiences.

Also true to the weirdness that seems inevitable in this job (and often in my life), the first traffic fatality I investigated was not typical.

The death was reported to me by paramedics around 2 am. It was described as a single-vehicle accident, one fatality, and no other persons or vehicles thought to be involved. A young man driving a small truck had collided with a chain link fence and subsequently impacted with a tree.

We had two scene bags; I grabbed the one that was not used most recently thinking it would be well-stocked (my first mistake). Then I got horribly turned around trying to find the scene, which is now laughable to me as it was on a well-traveled, easy to find road. (Hey, it was dark and I was new to the area!) I finally arrived at the scene only to find that the Polaroid camera was out of film with no restock in the bag, and the 35mm slide camera was frozen (literally) with a dead battery. Fantastic. Pictures are vitally important in documenting scenes. Fortunately the local police took an abundance of pictures and processed a set for our office.

It was a frigid night – below 20 degrees is unusually cold for early December in southeastern PA. The police and I painstakingly took measurements of tire marks, drew sketches of the scene, and finally I examined the body.

While plain ethyl alcohol itself has very little odor, the commingling of blood and ethyl alcohol forms the toxic metabolite acetaldehyde, which produces a very distinct odor not easily forgotten - and very easily identified. I got to the point where I could often detect the presence of alcohol approaching any recently dead, exsanguinating decedent. If it hadn’t been clear from the circumstances of the accident that this driver was impaired, it was evident from the strong smell of his blood that alcohol was involved.

This brings us to what was not routine about this accident. The majority of single-vehicle fatalities involve impact injuries to the head and/or chest, whether it is from being ejected or from hitting the steering column and/or windshield.

This man was impaled.

His truck hit the chain link fence, kept going, and as it impacted with the tree, a metal post from the fence was pushed through the windshield, through his body, and into the seat. The police removed the post. I reached into his chest cavity and removed the metal clamp that once held the post to the links. Another one was found buried much deeper during his autopsy the next day.

Most of the vehicular accidents I investigated during my five years were alcohol related. In this case, the decedent’s BAC turned out to be well over .20. I did have some other vehicular scenes that were not alcohol related - five or six were with the elderly and/or infirm who died prior to the vehicle crashing. A few involved high speed carelessness with no chemical impairment. Then there were a few motorcycle fatalities (“donorcycles” as they are crudely referred to in the medical and forensic worlds). And still a few more were just strange, freak accidents.

These are so difficult for family and friends, often because they are preventable and sometimes because they are senseless. I lost a friend in middle school to an accident in which someone ran a stop sign and he was ejected. Another friend in high school died in a similar accident, only the driver of this one was the car he was riding in - he was also ejected.

I've heard police say on more than one occasion "I've never unbuckled a dead person."

I have. I'm still a pretty big proponent of seat belts. I also support wearing helmets on motorcycles, even though in every motorcycle fatality I investigated the decedent was wearing a helmet and still died of head injuries. Oftentimes, people are not as invincible as they'd like to think, and explaining this sad truth to people who are having a very tough time grasping that a loved one is dead is a delicate task. Asking a mother who speaks almost no English to identify her young daughter's bloody clothing because the body was too mangled from the accident to be viewable, then holding her upright as she screams and cries hysterically is not something I care to repeat.

The next chapter is about another vehicular accident; while it was not my scene, it rocked the very foundation of our office.